Nocardia brain abscesses mainly occur in immunosuppressive hosts1 and comprise only 2% of all intracranial abscesses. It is difficult to identify central nervous system infections in patients with systemic lupus erythematosus because of the silent clinical manifestations and their simulation of lupus encephalopathy.2

Objective: We present a case of pheochromocytoma with fatal paroxysmal dyspnea hemoptysis and shock. A systematic review of literature on pheochromocytoma was performed to improve the understanding of the clinical manifestation, diagnosis and treatment of a typical pheochromocytoma. Methods:The clinical manifestation, diagnostic examination, operation mode and pathological characteristics of the typical pheochromocytoma, were analyzed and summarized. Simultaneously relevant literature was reviewed. Results:A 29-year-old male was diagnosed with pheochromocytoma with hemorrhagic cysts though without any typical clinical manifestation such as paroxysmal hypertension headache diaphoresis and palpitation. We treated this case as functional pheochromocytoma during the perioperative preparation although there were not enough evidence supporting that the tumor was pheochromocytoma. After sufficient preoperative preparation one of the adrenal grands was surgical resected and the diagnosis was confirmed on histopathology. Postoperation follow-up showed that the patient had a good prognosis after six months. Conclusion:The manifestations as we reported in this article fatal paroxysmal dyspnea hemoptysis and shock are quite rare as initial manifestations in pheochromocytoma. It showed that the initial manifestations of pheochromocytoma are complicated and deserve an appropriate examination and careful handling, which might reduce the misdiagnosis and surgical risk.